Provider Demographics
NPI:1710122643
Name:DONAGHY, ANNETTE L (ANNETTE DONAGHY, MA)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:L
Last Name:DONAGHY
Suffix:
Gender:F
Credentials:ANNETTE DONAGHY, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 LOGAN MILL RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-8716
Mailing Address - Country:US
Mailing Address - Phone:720-988-4862
Mailing Address - Fax:
Practice Address - Street 1:1800 30TH ST
Practice Address - Street 2:220 E
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1088
Practice Address - Country:US
Practice Address - Phone:720-988-4862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1291101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional